Key point: True allergy to poly-L-lactic acid is rare. Most post-Sculptra problems are delayed inflammatory nodules/foreign-body granulomas or biofilm infection. Treatment depends on the pattern. 1) Immediate allergic-type reaction (minutes–hours): hives, facial/airway swelling, wheeze. Stop further exposure. Oral/IV antihistamines + corticosteroids; epinephrine if anaphylaxis. Document potential culprits (PLLA, carboxymethylcellulose, mannitol, added lidocaine) and avoid PLLA/CMC in future. Allergy referral. 2) Delayed lumps/swelling (weeks–months): most common. Rule out biofilm/infection (ultrasound helpful). If suspected → doxycycline or macrolide course (often 4–8 wks). Intralesional triamcinolone (2.5–10 mg/mL) ± 5-fluorouracil (10–50 mg/mL) every 4–6 wks until flattening. Short oral steroid taper for extensive inflammatory swelling. Refractory cases: case-report options include allopurinol or minocycline for anti-granulomatous effect; consider biopsy to confirm diagnosis. Hyaluronidase does not work (Sculptra isn’t hyaluronic acid). Surgical excision only for small, resistant nodules. 3) Supportive steps Avoid additional Sculptra; choose HA fillers only once fully settled. Treat concurrent triggers (dental infections, procedures in the area). Expect resolution to take months and often multiple sessions. Bottom line: Yes—reactions after Sculptra are usually manageable with steroids (local ± systemic), 5-FU, and/or antibiotics when biofilm is suspected, plus avoidance of further PLLA. True immediate allergy is treated like any other hypersensitivity emergency.